Treatment decisions regarding re-irradiation of head and neck cancer in the 90s

The use of re-irradiation for the treatment of recurrent head and neck malignancies has been reported to re-establish local control in the re-treatment area in up to 80% of selected patients. However, these impressive statistics do not often translate into patient survival (except for select subsets such as recurrent nasopharyngeal malignancies). Additional, the brave new world of managed health care have created pressures to determine not only the therapeutic outcomes, but its relationship to economic and quality of life outcomes for these most unfortunate patients. The purpose of this paper is to critically review recent series regarding re-irradiation of head and neck cancers, and to put forth a recommendation for collaborative study that will determine not only the best management for recurrent for head and neck malignancies, but also help to define through the various outcome measures the most cost effective management.